Salvage surgery vs. repeat stereotactic radiosurgery for progressing vestibular schwannomas
Reviewed by Gauri Mankekar

This large multicentre case series of patients treated twice with stereotactic radiosurgery (SRS) for progressing vestibular schwannomas (VS) is reported by the International Gamma Knife Radiosurgery consortium. Progression of tumour growth after primary SRS is rare but does occur. Complications following SRS has been a major hurdle in recommending SRS twice to patients with VS. The authors report that failure occurred at a median of 45.4 months after primary SRS with more than 50% of the patients showing tumour regression or stability. The median interval between the two SRS treatments was 54 months. According to the data, the authors hypothesise that VS which progress after the first course of SRS may not be resistant to radiation. The authors conclude that a second course of SRS in progressive VS is safe and can help to effectively manage progressing tumours. The study describes the safety profile for repeat SRS as being much better than salvage surgery. Future studies by the consortium focusing on long-term MRI follow-up of the VS after primary SRS may help to provide guidelines for differentiating pseudoprogression versus actual tumour progression.

Repeat Stereotactic Radiosurgery for Progressive or recurrent Vestibular Schwannomas.
Iorio-Morin C, Liscak R, Vladyka V, et al.
NEUROSURGERY
2019:85(4):535-42.